FOR INVESTOR USE ONLY
TransformingCancer Care
Investor Relations
September 16, 2019
FOR INVESTOR USE ONLY
AgendaInnovation Highlights
Oncology Systems & Adaptive TherapyChris Toth
President, Oncology Systems
CTSIAndrew Shogan
SVP, CTSI
NoonaCorey Zankowski
SVP, Oncology Software Solutions
Interventional OncologyKolleen Kennedy
President, Proton Solutions and Chief Growth Officer
Proton Solutions & Flash TherapyKolleen Kennedy
President, Proton Solutions and Chief Growth Officer
Dee Khuntia
SVP, Chief Medical Officer2
IntroductionJ. Michael Bruff
SVP, Finance and Investor Relations
Company Overview & StrategyDow Wilson
President and Chief Executive Officer
Innovation Highlights
Q&A and Closing RemarksDow Wilson
President and Chief Executive Officer
1
2
3
4
This presentation is intended exclusively for investors.It is not intended for use in Sales or Marketing.
Forward-Looking StatementsExcept for historical information, this presentation contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995.
Statements concerning industry outlook, including growth drivers, future trends in cancer incidence and trends in cancer treatment needs, demand, innovation and
growth opportunities; Varian Medical System, Inc.’s (”Varian” or the “company”) future orders, revenues, backlog or earnings growth; future financial results; market
acceptance of or transition to new products or technology such as our Edge® radiosurgery system, TrueBeam®, HyperArcTM, 360 OncologyTM, HALCYONTM, image-
guided radiation therapy, stereotactic radiosurgery and proton therapy, and any statements using the terms “could”, “believe”, “expect”, “outlook”, “anticipate”, ”vision”,
“estimate”, “future”, “horizon”, “aiming”, “driving”, “target” or similar statements are forward-looking statements that involve risks and uncertainties that could cause the
company’s actual results to differ materially from those anticipated. Such risks and uncertainties include global economic conditions and changes to trends for cancer
treatment regionally; new and potential future tariffs or a global trade war; the impact of changes to the Affordable Health Care for America Act (including excise taxes
on medical devices) and any further healthcare reforms (including changes to Medicare and Medicaid), and/or changes to third-party reimbursement levels; currency
exchange rates and tax rates; the impact of the Tax Cuts and Jobs Act; demand for the company’s products; the company’s ability to develop, commercialize, and
deploy new products; the company’s ability to meet Food and Drug Administration (FDA) and other regulatory requirements for product clearances or to comply with
FDA and other regulatory regulations or procedures, changes in the regulatory environment, including with respect to FDA requirements; the company’s assessment
of the goodwill associated with its proton business, challenges associated with the successful commercialization of the company’s proton business; the risks
associated with providing financing for the construction and start-up operations of proton therapy centers; the effect of adverse publicity; the company’s reliance on
sole or limited-source suppliers; the company’s ability to maintain or increase margins; the impact of competitive products and pricing; the potential loss of key
distributors or key personnel; challenges to public tender awards and the loss of such awards or other orders; and the other risks listed from time to time in the
company’s filings with the Securities and Exchange Commission, which by this reference are incorporated herein. The company assumes no obligation to update or
revise the forward-looking statements in this presentation because of new information, future events, or otherwise. Reconciliations to GAAP financials can be found in
our earnings press releases at www.varian.com/investors.
Medical Advice DisclaimerVarian as a medical device manufacturer cannot and does not recommend specific treatment approaches. Individual treatment results may vary.
FOR INVESTOR USE ONLY3
FOR INVESTOR USE ONLY
Dow Wilson
President and Chief Executive Officer
Company Overview & Strategy
FOR INVESTOR USE ONLYFOR INVESTOR USE ONLY
Physician Mobile
Nurse Navigation
Flowsheet
Symptom Management
Multidisciplinary tumor board
Care Team Coordination
Practice Management
Medical Oncology
Radiation Oncology
RT chart rounds
Treatment planning
Drugordering
Simulation Treatment verification
Pharmacy dispensing
Dose management
Electronic prescription
Chargecapture &
billing
Informatics & Analytics
AI &Machine Learning
• Electronic referrals
• Registration
• Scheduling
Patient EngagementPatient Intake
Screening Diagnosis
• Documentation& Staging
• Tumor board
• Genomics
Follow-up
• Symptom management
• PRO
• Education
• Follow-up Radiomics
Survivor-ship
• Survivorship care plans
Surgical Oncology
Immuno-Oncology
Interventional Oncology
FOR INVESTOR USE ONLY5
Varian: 1948 to 2010
Global leader in RORadiation Oncology company focused on adjacent software opportunities along the cancer care continuum
FOR INVESTOR USE ONLYFOR INVESTOR USE ONLY
6%
7%
8%
FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18 FY19 YTD
6
R&
D a
s a
% o
f re
ve
nu
es
R&D investments delivering world class integrated portfolio
with RapidPlanMCO/GPU
Voice of the customer informs investment decisions
Q3
FOR INVESTOR USE ONLYFOR INVESTOR USE ONLY
Varian’s comprehensive cancer care portfolio
7
ARIA®
Oncology Information System
360 Oncology™
Care Management Platform
ConnectivityEpic, Cerner, ARIA Connect
Halcyon™ TrueBeam® VitalBeam™
Trilogy® Clinac® UNIQUE™
Radiotherapy Systems
ProBeam®
ProBeam® 360°Proton Therapy Systems
Calypso® systemReal-Time Tracking Technology
Edge™Radiosurgery System
Bravos™Product Suite for Planning and Delivery
Cancer Treatment
Analytics
Image Management
TreatmentPlanning
Radiation Therapy
ProtonTherapy
Radio-Surgery
BrachyTherapy
OIS
Partnering
Care
Coordination
Eclipse™
Treatment Planning System
Velocity™
Oncology Image Informatics
InSightive™
Analytics
Hardware & Software Services
FOR INVESTOR USE ONLYFOR INVESTOR USE ONLY8
Key acquisitions
20122011 2014 20162015 2018
CandelaAcquisition of Poland
distributor
TranspireTreatment planning
software
VelocityTreatment software
R-PORTCancer care planning
tool
Calypso Medical
TechnologiesReal-time tumor tracking
and motion management
2013 2017
Cialfarm SARLJoint venture to establish
operation in Algeria
Fraunhofer ITWMLicensing deal to
integrate MCO with
Eclipse
CTSIaccelerate identification of
unmet clinical needs to
facilitate advances in tech-
enabled services
Endocare & AliconEntrance into interventional
oncology
Boston Scientific
beads portfolio Additional interventional
oncology assets
CyberHeartAdds technology for cardiac
radioablation
2019
humediQPatient ID; motion
management software
COOPAcquisition of Taiwan
distributor
EvinanceClinical decision
support software; 360
oncology
MobiusQuality assurance
software
Noona
HealthcareMobile service to
capture patient-
reported outcomes
FototronicEstablished direct
operations in Hungary
Prior to Varex spin-off, acquisitions were focused on
growing core radiation therapy business
Expanding into
broader cancer care market
Acquisition to expand market
Acquisition to support core radiotherapy business
FOR INVESTOR USE ONLYFOR INVESTOR USE ONLY
Varian today – a snapshotTouching more than 4+ million patients per year1
9
RT LEADER: +12% Revenues and +11% Orders Oncology Systems TTM
growth with largest global installed base
SOFTWARE: +16% TTM Software revenues growth
SERVICES: NPS2 of 78 with +7% TTM Services revenues growth
CTSI: Powering new technology-enabled services to drive mature market
productivity and emerging market adoption
INTERVENTIONAL ONCOLOGY: Faster growing adjacent market with
accretive gross margin profile; leveraging Varian treatment planning capabilities
PROTON: 3 orders in Q3 FY19 YTD; 26 sites globally with 79 rooms; Flash
preclinical studies remain encouraging
(1) Based on company estimates and data(2) IMV 2019 ServiceTrak – Radiation Oncology Systems Report
Medical
Oncology
&
Immuno-
therapy
Diagnosis
Radiation
Oncology Proton
Equip
Services
Provider-Based
Services
Interventional
Oncology
Software
Tech-Enabled
Services
Surgical
Oncology
FOR INVESTOR USE ONLYFOR INVESTOR USE ONLY10
6,031
8,412
FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18 FY19YTD
Net installed base
Q3
FY19
YTD
Drivers of Installed Base Growth
Investing in field capacity focused on emerging
markets, upgrades and software
Innovation in integrated hardware, software and
services portfolio
Estimated global market installed base >12,0001
(1) IAEA Directory of Radiotherapy Centres (DIRAC)
Largest linear accelerator installed baseNet installed base trend
FOR INVESTOR USE ONLYFOR INVESTOR USE ONLY
15.1%
17.7%
16.6%
17.9%
10.0%
12.0%
14.0%
16.0%
18.0%
$300
$350
$400
$450
$500
$550
$600
$650
FY17 FY18 Q3 FY19 TTM
Operating Earnings
Operating Margin
+15%
Y/Y
Varian revenue mix and operating earnings recent trends
11
+31%
Y/Y
48% 46% 45%
52% 54% 55%
FY17 FY18 Q3 FY19 YTD
International as % of Total Revenues
North America as % of Total Revenues
ex. Tariffs*
Non
-GA
AP
Op
era
tin
g e
arn
ings (
$M
)
Non
-GA
AP
Op
era
ting e
arn
ings a
s %
of re
ve
nu
es
ex. Tariffs*
TTM Q3 FY19
Operating Earnings as % of Revenues
* Excludes the gross impact from additional tariffs
Notes: Excluding FY17 Proton AR reserve operating earnings would be $433M (16.5% of revenues) and
FY18 operating earnings Y/Y growth would be +19%
+6%
Y/Y
FOR INVESTOR USE ONLYFOR INVESTOR USE ONLY
19%
49%
81%
51%
FY05 FY06 FY07 FY08 FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18 Q3FY19YTD
Varian revenue mix changing
12
Oncology HW and SW Licenses
Oncology orders remains a relevant leading
indicator for future hardware and software revenue
Recurring-type revenues (e.g. HW services and SW
service agreements) increasing as percent of total
revenues
Emerging businesses and technologies revenues
have different business models and leading
indicators (e.g. consumables, per patient, total contract
value, annual recurring revenues)
Services and Other
Note: Excludes Varex; ASC 605 to 606 restated from FY16 forward; “Services and Other” includes revenues from Proton, CTSI, and Interventional
FOR INVESTOR USE ONLYFOR INVESTOR USE ONLY
Physician Mobile
Nurse Navigation
Flowsheet
Symptom Management
Multidisciplinary tumor board
Care Team Coordination
Practice Management
Medical Oncology
Radiation Oncology
RT chart rounds
Treatment planning
Drugordering
Simulation Treatment verification
Pharmacy dispensing
Dose management
Electronic prescription
Chargecapture &
billing
Informatics & Analytics
AI &Machine Learning
• Electronic referrals
• Registration
• Scheduling
Patient EngagementPatient Intake
Screening Diagnosis
• Documentation& Staging
• Tumor board
• Genomics
Follow-up
• Symptom management
• PRO
• Education
• Follow-up Radiomics
Survivor-ship
• Survivorship care plans
Surgical Oncology
Immuno-Oncology
Interventional Oncology
FOR INVESTOR USE ONLY13
Varian: 1948 to 2010
Global leader in RORadiation Oncology company focused on adjacent software opportunities along the cancer care continuum
FOR INVESTOR USE ONLY
Symptom Management
Multidisciplinary tumor board
Care Team Coordination
Practice Management
Intelligent Cancer Care
RT chart rounds
Drugordering
Simulation Treatment verification
Pharmacy dispensing
Dose management
Electronic prescription
Chargecapture &
billing
Informatics & Analytics
AI &Machine Learning
• Electronic referrals
• Registration
• Scheduling
Intelligent Cancer Care:an information-driven, continuously learning technology ecosystem
Screening Diagnosis
• Documentation& Staging
• Tumor board
• Genomics
Follow-up
• Symptom management
• PRO
• Education
• Follow-up Radiomics
Survivor-ship
• Survivorshipcare plans
Varian: Today
FOR INVESTOR USE ONLY14
Radiation Oncology
MedicalOncology
Surgical Oncology
Immuno-Oncology
Treatment planning
Interventional Oncology
as-a-service
Patient IntakePatient
Engagement
Physician Mobile
Nurse Navigation
Flowsheet
FOR INVESTOR USE ONLY
Chris Toth
President, Oncology Systems
Oncology Systems
ASTRO 2019 highlights • Varian Users Meeting: >1,100 customers
− Key Opinion Leader Presentations
− Ethos first patient treatments featured
• Ethos launch – World’s 1st AI adaptive RT system
− Approximately 150 demos to customers (Sunday)
• Adaptive Intelligence Consortium Meetings
• Taiwan & China Users Events
• SROA Interactive Software Workshop
• Halcyon/HyperArc Users Roundtable
• IMV Service Awards (Varian 1st in all categories)
− Customer Satisfaction
− Overall System Performance
− Service
16 FOR INVESTOR USE ONLY
The Gap in Care is WideningDemographics driving needs & market growth
17 Current RT market growing mid-single digits
with increasing global demand*17 FOR INVESTOR USE ONLY
* Based on company estimates and data
Innovative solutions addressing market demandInstalled base replacement & expansion opportunities
FOR INVESTOR USE ONLY18
$8.7B Installed
Base replacement
opportunity*
TrueBeam® Halcyon™
$3B Software Portfolio Opportunity*
Eclipse™
Treatment PlanningVelocity®
Image ManagementARIA®
Oncology EMR360 Oncology™
Care Coordination
SRS/SBRT & new standards of
care driving replacement cycle
with TrueBeam® & Halcyon™
Brain metastases = most
common recurrence, powering
HyperArc™ demand
Learning curve reduced and
quality increased with machine
learning RapidPlan™ & MCO
* Based on company estimates and data
19
World’s 1st AI powered adaptive therapy system
FOR INVESTOR USE ONLY
Realizing Personalized Adaptive Radiation TherapyThe culmination of a multi-decade pursuit of innovation
20
1995-2000
IMRT: dose
conformity &
fidelity
2005-2010
IGRT: target
precision
positioning
BUT, patients’ anatomy &
tumors change
GOAL: Maximize dose to tumor, minimize to healthy tissueFOR INVESTOR USE ONLY
Realizing Personalized Adaptive Radiation TherapyThe culmination of a multi-decade pursuit of innovation
21
1995-2000
IMRT: dose
conformity &
fidelity
2005-2010
IGRT: target
precision
positioning
Today and beyond• Personalizing treatment daily
• Adapting to anatomy & tumor changes
• Powered by Artificial Intelligence (AI)
• Standard 15 min treatments
Ethos: characteristic spirit of
a culture, era, or community
GOAL: Maximize dose to tumor, minimize to healthy tissueFOR INVESTOR USE ONLY
FOR INVESTOR USE ONLY
Revolutionary workflow & integration
Booth Demo: Monday Sep. 16 @ 4:30pm – 5:00pm CT
CE Mark
510 (k) Pending
1st Patient treated
Initial
planning
On-couch
adaption (~15 min)Treatment
monitoring
• Interactive 3D prescriptions
• Automated segmentation
• Multiple plan generation
• Setup and CBCT ~3 min
• Automated segmentation ~2 min
• Contour evaluation ~3 min
• Plan generation ~3 min
• QA and plan review ~1 min
• Treatment delivery ~3 min
• Automated dose monitoring
• Automated structure monitoring
• Assisted off-line adaptation
Automated multi-modality image fusion at any stage
1 2 3
22 FOR INVESTOR USE ONLY
23
24
FOR INVESTOR USE ONLY25
Ethos Therapy™World’s 1st AI powered adaptive therapy solution
1. AI-driven, streamlined workflows
2. Access to CT, MR, PET images
3. Patient Centric, 100cm bore/quiet delivery
Enabling adaptive
treatment delivery in the
typical 15-minute timeslot!
FOR INVESTOR USE ONLY
5
First Patients Treated!
14 Fractions
Sep 9 - 12
Patients treated
12 minAvg time per fraction
Rectum
3
"We have already delivered the first Ethos therapy treatment and our clinical staff were impressed by the capabilities and the ability to deliver this advanced treatment in a typical timeslot.”
“Ethos therapy will enable our physicians to better visualize the changes in a patient’s anatomy and quickly adapt the therapy accordingly to help provide better treatments to patients,”
Dr Poul Geertsen, MD, PhD, Head of Radiotherapy, Department of Oncology, Herlev and Gentofte HospitalSarcoma1
Bladder
126
per fraction adaptive workflow
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Adaptive Intelligence Consortium
27
Goal: Accelerate adoption and provide evidence of clinical\outcome benefits
Committed and potential
consortium sites
KINDAI UNIVERSITY
FOR INVESTOR USE ONLY
Andrew Shogan
Senior Vice President, CTSI
CTSI
VARIAN CONFIDENTIAL – INTERNAL USE ONLY
CTSI oncology platform
• Founded in 2008 by a group of oncologists from UPMC
• Facilitate improved accessibility to and affordabilityof high-quality cancer care
• Differentiated clinical services to local patients by local clinicians within a financially viable model
• CTSI OS extends core capabilities to other providers
Diagnostic, therapeutic and clinical support delivery capabilities in any global market
29
Oncology
Services
▪ Medical physics
▪ Clinical dosimetry
▪ Oncology IT
▪ Clinical pathways and
decision-support tools
▪ Training and education
▪ Clinical workflow
Clinical
Delivery
▪ Medical oncology
▪ Radiation oncology
▪ Surgical oncology
▪ Multidisciplinary surgery
▪ BMT programs
▪ OP procedures
▪ IP oncology care
Diagnostic
Services
▪ Histopathology
▪ Molecular Pathology
▪ Cytogenetics
▪ Flow Cytometry
▪ Immunoassay (cancer
markers)
▪ NextGen Sequencing (NGS)
CTSI Oncology Platform
▪Decades of experience across global markets
▪20,000+ cancer patients treated annually
▪35,000 historical complex Tx plans and data sets
▪>50% revenue CAGR
▪>9,000 Tx plans delivered annually
▪>2m lab tests performed annually
FOR INVESTOR USE ONLYFOR INVESTOR USE ONLY
VARIAN CONFIDENTIAL – INTERNAL USE ONLY
CTSI strategy accelerating global access to quality care
30
Early global examples
PNG
Clinical services
and training
China professional
services
Clinical services
support
Technology
implementation
Technology and
clinical partnership
Vija
Medtech
Clinical services
support
FOR INVESTOR USE ONLY
VARIAN CONFIDENTIAL – INTERNAL USE ONLY
Illustrative opportunity: UMC Health System
• Large public health system and primary teaching hospital for Texas Tech University
• Increasing levels of support over the past two years
• Numerous achievements that support expansion of UMC’s oncology program
Clinical services engagement
31
$0.0
$0.5
$1.0
$1.5
$2.0
2017 2017 2018 2019 2019
Annualiz
ed R
ecurr
ing
Reve
nue (in m
illio
ns)
SafetyNet
assessment
Centralized
physics
supportTechnology
management
and software
support
Strategic support for
RO and MO program
Expanded RO
programmatic
support
$1.65mAchievements to date
▪ Programmatic improvements
▪ Improved staff morale
▪ Increased volume by 30% and revenue by 35%
▪ ACR compliance
▪ Increased HDR and SRS workload
▪ Commissioned several new technologies
FOR INVESTOR USE ONLY
VARIAN CONFIDENTIAL – INTERNAL USE ONLYCreate and deploy clinically relevant solutions resulting in better care for patients
Varian + CTSI: Solutions for unmet patient & provider needs
Brings Varian closer to the
patient and provider to
gain data driven clinical
insights
32
Enables enhanced tech-
enabled services to bridge
skills gap
Drives development of new
tech-enabled services
Feedback loop of data will drive cost- and time-effective innovation
FOR INVESTOR USE ONLY
Corey Zankowski, PhD
Senior Vice President, Oncology Software Solutions
Noona
FOR INVESTOR USE ONLY
Noona overview
34
Patient symptom management
& patient reported outcomes
Expanding number of patients touched
22,000 new cases per year
19 cancer programs in Michigan
3-yr project: breast, lung, colorectal
1st patient July 19
20,000 new cases per year
All indications, 32 clinics live
Strategic long-term partnership
Acquired Noona Healthcare October 2018,
developer of a cloud-based, mobile service to capture
cancer patient-reported outcomes (PROs)
‒ Designed to capture structured PRO data
‒ Includes proactive patient symptoms
management
‒ Superior UI/UX (modern & engaging app)
‒ May improve clinical outcomes and reduce
hospitalization
‒ Complements patient engagement platform
‒ Biz models for MO and Pharma as customers
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Commercial model combines SaaS and life sciences sponsored studies to drive revenue for Noona
FY20 Provider SaaSProvider SaaS +
Studies
Life Sciences
(Pharma)Payers
Customer
Segment
Private practice
networks
Selected group of
IDNs
Selected group of
AMCs
Private practice
networks
ARIA MO premium
clients
TOP 15 Pharma
Immunotherapies and
new oral drugs
Post-marketing
studies
Blue Cross Blue
Shield
Humana
Example of
customersNew Mexico Cancer
CenterTennessee Oncology
BMS
Takeda
Michigan Oncology
Quality Consortium
3535 Market opportunity: ~$2 B for Provider SaaS + Studies and for Life Sciences*35
* Based on company estimates and data
FOR INVESTOR USE ONLY
Kolleen Kennedy
President, Proton Solutions and Chief Growth Officer
Interventional Oncology
FOR INVESTOR USE ONLY
Acquisitions provide leading position
37
Expand Varian’s addressable market to include interventional oncology
* Based on primary and secondary research conducted by Kaiser Associates
448541
86
140
334
369
$0
$200
$400
$600
$800
$1,000
$1,200
2019 2022
US China ROW
$1,050
$868• The first and only provider with an end-
to-end suite of integrated hardware and
software solutions
• Very high right-to-win with a global
commercial footprint & strong core
competencies
• Extend Varian footprint across the
cancer care continuum delivering on
strategic growth objective
1
2
3
Why enter interventional
oncology market?
Interventional Oncology WW Market Value ($M)*
Overview of interventional oncology treatment modalities
38
Ablation Embolization
Use of concentrated thermal energy to either heat/burn or
freeze tumor
Cryotherapy
Tiny particles block tumor’s access to blood, causing
tumor to “starve”
Heat ModalitiesFreeze Modality
Microwave (MWA)
Radiofrequency (RFA)
“Iceball” forms
Beads clump,
block blood
Embolization Only Embolization + Loco-regional RT/Chemo
Acquired assets✓
Tumor burned; spherical
heat zone forms
Acquisitions provide assets in thermal ablation and microsphere embolization
✓
✓Bland Beads
Embolization
✓ Radio-
Embolization
(“Y90”)
Chemo
Embolization
(“cTACE,” “DEB-
TACE”)*
FOR INVESTOR USE ONLY
FOR INVESTOR USE ONLY
Varian’s vision for an interventional oncology platform
39
Software
Build robust
ecosystem of
interventional
oncology planning
and decision
support software
Ablation
Cryoablation
Microwave
ablation
China
Bland resorbable
gel foam particles
Embolic beads
Embolization
Oncozene/
Embozene
Tandem1
Embozene
Boston Scientific
Beads Portfolio
Hardware and software solutions spanning multiple modalities
(1) Marketed as Oncozene in US, Embozene Tandem (or “Tandem”) OUS
FOR INVESTOR USE ONLY
Building a comprehensive and differentiated platform offering
40
Next steps in building Varian’s interventional oncology ecosystem
Priorities for the
business
Build global commercial team including direct sales and
distribution network
Expand cryotherapy and microwave product sales into new
markets worldwide
Invest in R&D organic portfolio development
Establish microsphere manufacturing team in Austin
Leverage Varian software expertise to build differentiated
solution suite offerings
FOR INVESTOR USE ONLY
Kolleen Kennedy
President, Proton Solutions and Chief Growth Officer
Proton Solutions
VOLUME
ProBeam® 360° Proton Therapy SystemDesigned for Next-Generation Proton Therapy in a Smaller Footprint
30%SmallerFootprint
25%Reduction in vault cost
50%SmallerVolume
42
ProBeam 360° (2 gantry)
Legacy 2 gantry System
FOOTPRINT
Reductions dependent on configurationFOR INVESTOR USE ONLY
Now available in multi-room configuration
Smallest multi-room system available for sale
43 | VARIAN CONFIDENTIAL/PROPRIETARY: DISCLOSED FOR IMMEDIATE RECIPIENT ONLY
Bridge IMPT
learning curve
Modality Decision
support
Increase plan
quality & QC
RapidPlan PTThe first application of Machine
Learning for proton planning
TM
43FOR INVESTOR USE ONLY
Brain Model by NRG
H&N Model by VUMC
Base of Skull Model by PSI
Craniopharyngioma Model by CCHMC
Liver HCC Model by Varian
Gynecologic Model by Glasgow
RapidPlan™ PTRapidly expanding model-building proton community
FOR INVESTOR USE ONLY
Dee Khuntia, MD
Senior Vice President and Chief Medical Officer
Flash Therapy
FOR INVESTOR USE ONLY
FLASH Publication TimelineInvestments in FLASH research activities started in 2015 and with our FlashForward™ Consortium announcement last year, the fervor has only grown
46
38 FLASH/FLASH related publications by midyear 2019
18 9
1821
38
2014 2015 2016 2017 2018 2019
FLASH Publications2014-Present
FLASH therapy is under preclinical research. It is not available for clinical use and there is no guarantee of future commercialization
FOR INVESTOR USE ONLY
400 cGy
2,400 cGyTrueBeam
Clinac
TrueBeam
Clinac
ProBeam
FLASH
ProBeam
FLASH
720,000 cGy
0 cGy 100000 200000 300000 400000 720000500000
Per min
10,000 cGy
Ultra-high dose external beam therapy delivered in less than 1 second, in 1 to 3 treatments
47
FLASH Range
40 Gy/sec – 120 Gy/sec
ProBeam Research Mode
FLASH therapy is under preclinical research. It is not available for clinical use and there is no guarantee of future commercialization
FOR INVESTOR USE ONLY
Varian FlashForward™ Program
48
2014 2015 2016 2017 2018 2019
IP IP
University
of MarylandDept of Radiation Oncology
CincinnatiProton Therapy Center
First Proton FLASH
Toxicity Study
Favaudon et al.,
Sci. Transl. Med.,
16 Jul 2014
First Proton FLASH
Tumor Control Study
Electron FLASH
Toxicity and Tumor
Control Studies
Stanford University
Medical Center
First Investigations
into Ultra-high Dose
Rates using protons
U.S. No. 9,855,445
Varian filed First Patent for
FLASH - Radiation therapy
systems and methods for
delivering doses to a target
volume > 4 Gy/sec
Varian modified a non-
clinical Clinac to study
ultra-high dose rates
using electrons
Varian filed an additional 14
patents in the U.S. and 9
counterpart filings
internationally
IP
Varian granted 5U.S. patents for
FLASH innovations
20+ patents pending
FLASH therapy is under preclinical research. It is not available for clinical use and there is no guarantee of future commercialization
VARIAN CONFIDENTIAL/ PROPRIETARY: DISCLOSED SOLELY FOR IMMEDIATE RECIPIENT ONLY
ProBeam® Proton Therapy Sites 2019
Operational centers Centers Under Development
26ProBeam
SitesTotal
Rooms
79Operational
Rooms*
33
49
*Number of operational rooms may not sum up to the total number on the map due to some site having rooms which are under development
FlashForward Consortium Member
FOR INVESTOR USE ONLY
FOR INVESTOR USE ONLY
Multifaceted FLASH Strategy
Safe TreatmentsMechanism of Action Long-term Research
FLASH therapy is under preclinical research. It is not available for clinical use and there is no guarantee of future commercialization
50
FOR INVESTOR USE ONLY
Normal Lung Tissue
Conventional
Protons
Flash
Protons
1,294
639
37
40
Flash reduces differential gene expression normally observed with radiation therapy
Different genes are up or down
regulated when comparing treatment
groups versus the (untreated)
control group.
FLASH Protons have a gene
expression profile closer to the
(untreated) control group.
24 hr
Up-regulated genes
Down-regulated genes51
15
13
UP
DOWN
FOR INVESTOR USE ONLY
FOR INVESTOR USE ONLY
Control ConventionalFLASHFLASH Proton Conventional Proton
FLASH induces infiltration of CD3+ cells immune cells in mice
Control
CincinnatiProton Therapy Center
Control FLASH Conventional
Tumor Core
Tumor Core
FLASH therapy is under preclinical research. It is not available for clinical use and there is no guarantee of future commercialization
52
FOR INVESTOR USE ONLY
Publications 2019 (FLASH) – National & International Meetings
53
• AACR: Meeting March 29 – April 3, 2019
➢ Girdhani, Parry et al – FLASH: a novel paradigm changing tumor irradiation platform that enhances therapeutic ratio by reducing
normal tissue toxicity and activating immune pathways
• PTCOG: Meeting June 10-15, 2019
➢ Abel, Parry et al – Planning and Delivery of FLASH in a clinical ProBeam: A preclinical study
➢ Busold, Heese et al – Proton beam diagnostics for ultra-high dose rate irradiations
➢ Magliari, Perez et al – Ultra-high dose rate proton treatment planning
• ISRS: Meeting June 9-13, 2019
➢ Ku, Parry et al – Oral Presentation- Molecular profiling of high dose irradiated tissues identifies differential gene expression profiles
between conventional and high dose “Flash” protons.
• AAPM: Meeting July, 24-19, 2019
➢ Katsis, Parry et al - Treatment planning and dose monitoring for small animal proton FLASH irradiations
• ASTRO: Meeting September 15-18, 2019
➢ Abel, et al - Characterization of radiation induced lung fibrosis and mode of cell death using single and multi-pulsed proton FLASH
irradiation
➢ Rama, et al - Improved tumor control through T-cell infiltration modulated by ultra-high dose rate proton FLASH using a clinical pencil
beam scanning proton system
• Publications:
➢ Proton FLASH: a novel paradigm changing tumor irradiation platform that enhances therapeutic ratio by reducing normal tissue
toxicity and reducing inflammatory pathways, Girdhani , et al – publication finalized and prepared for submission
➢ A Review of FLASH radiotherapy – The Past, Present, and the Future, Khuntia et al. In preparation
FOR INVESTOR USE ONLY
Dow Wilson
President and Chief Executive Officer
Q&A and Closing Remarks
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Varian to host 2019 Investor Day meeting in NYCShare our vision for a world without fear of cancer…
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• Time:
8:00am to 1:00pm ET on November 15, 2019
• Location:
The Plaza Hotel, Fifth Avenue at Central Park South, New York, NY 10019
• Objective:
Varian’s management team will outline growth initiatives in radiation oncology,
interventional oncology, and more broadly across cancer care driven by our
'Intelligent Cancer Care' approach
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Varian leadership update – 1 year later
56
Kolleen KennedyChief Growth OfficerPresident, Proton Solutions
• Robust software revenue growth
of 16% TTM
• Accelerating software deployment
• Noona
• Technology-enabled services
Corey ZankowskiSVP, Oncology Software Solutions
Chris TothPresident, Oncology Systems
• Continued strong momentum in
the market (11% TTM oncology
orders)
• Adaptive therapy
• Tata Trusts deal
• CTSI
• Strengthening Proton business –
three new orders
• Flash program
• Interventional oncology
• Acquisition integration
• Cardiac radio-ablation
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Varian leadership team
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Dow Wilson
CEO
Clifton Ling
Dir, Advanced Clinical
Research
Kathy Conner
VP, Global Brand &
Marketing
Chris Toth
Pres, Oncology
Systems
Kolleen Kennedy
Pres, VPS & Growth
Office
Andy Whitman
SVP, Government
Affairs
John Kuo
SVP, Legal
Corey Zankowski
SVP, Oncology
Software Systems
Rafael Torres
SVP, Business Dev &
Strategy
Dee Khuntia
SVP, Medical Affairs
Terilyn Monroe
SVP, People & Places
Gary Bischoping
SVP, Finance & IT
Vy Tran
SVP, Reg Affairs and
Quality Systems
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In summary, we are…
…Driving toward our vision of a world without fear of cancer
Growing Varian Value Add through operational and capital efficiency
Continuing to strengthen leadership in radiation oncology
Leveraging artificial intelligence, machine learning and cloud solutions to drive efficiency and effectiveness
Growing emerging businesses and technologies
58 FOR INVESTOR USE ONLYFOR INVESTOR USE ONLY